Efficacy of the implementation of the National Emergency X-Radiography Utilization Study (NEXUS) II decision rule to clinical practice for pediatric head injury patients.

AIM: To investigate the usefulness of the National Emergency X-Radiography Utilization Study (NEXUS) II head trauma decision rule in clinical practice for pediatric patients in a tertiary university hospital serving as the only pediatric hospital in the area.

METHODS: We compared how doctors evaluated and examined patients with head injury during two time periods; before and after the introduction of NEXUS II decision rule. Multiple implementation strategies were used: education, tutoring and written instructions for the use of NEXUS II.

RESULTS: 244 head injury patients visited the hospital before and 385 after the introduction of the NEXUS II decision rule. The number of hospital admissions (56%) and the mean duration of hospitalization (2.5d) remained the same during the two periods. In the NEXUS II evaluated group, there was a decrease of 40% in the number of hospital admissions. NEXUS II was applied in only 62 (16%) cases. The number of head imaging procedures remained the same. No patients with a clinically significant head injury were missed with the NEXUS II evaluation.

CONCLUSION: NEXUS II was ineffective as our implementation failed. When used, NEXUS II reduced expenses in our study population by decreasing the number of hospital admissions.